| NPI | 1225435662 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK J MITREY Managing Director 602-284-8265 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: AZ 1023087293) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 1023087293) |
| 363LF0000X Nurse Practitioner, Family (Licence: AZ 1023087293) | |
| Enumeration Date | 2014-12-01 |
| Last Update Date | 2014-12-15 |